Clinical Reviewer I - Behavioral Health

Clinical Reviewer I – Behavioral Health

Our client, a leading healthcare organization, is seeking a Clinical Reviewer I – Behavioral Health to join their team. As a Clinical Reviewer I – Behavioral Health, you will be part of the Behavioral Health Utilization Management department supporting healthcare quality and member satisfaction. The ideal candidate will have strong clinical judgment, excellent communication skills, and the ability to work independently, which will align successfully in the organization.

Location: Meridian, ID

Pay Range: $42.23 an hour

What's the Job?

• Perform utilization management reviews for selected behavioral health services.
• Make clinical determinations based on established policies, procedures, and review criteria.
• Determine member eligibility and benefit coverage according to contracts.
• Respond to requests for authorization of medications, inpatient procedures, and services.
• Identify, document, and report potential quality of care or service concerns to leadership.

What's Needed?

• Minimum of 3 years of relevant Behavioral Health Utilization Management experience.
• Active, unrestricted Idaho license as a Registered Nurse (RN) or Social Worker.
• Strong knowledge of utilization management processes and review criteria.
• Ability to interpret member benefits, provider contracts, and coverage guidelines.
• Excellent clinical judgment, decision-making, and communication skills.

What's in it for me?

• Opportunity to work in a dynamic healthcare environment dedicated to improving patient outcomes.
• Engage in meaningful work that makes a difference in members' lives.
• Collaborate with a supportive team of healthcare professionals.
• Develop your skills and advance your career in behavioral health management.
• Work in a location that values diversity and inclusion, fostering a welcoming workplace culture.

Upon completion of waiting period associates are eligible for:

• Medical and Prescription Drug Plans
• Dental Plan
• Supplemental Life Insurance
• Short Term Disability Insurance
• 401(k)